Provider First Line Business Practice Location Address:
4849 CIVIC CENTER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-1679
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-780-2125
Provider Business Practice Location Address Fax Number:
323-780-2464
Provider Enumeration Date:
09/24/2010