Provider First Line Business Practice Location Address:
2521 LONG BEACH AVE
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:
90058-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-389-1500
Provider Business Practice Location Address Fax Number:
213-383-2493
Provider Enumeration Date:
03/22/2016