Provider First Line Business Practice Location Address:
5701 S HOOVER ST
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:
90037-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-493-1347
Provider Business Practice Location Address Fax Number:
310-635-0090
Provider Enumeration Date:
04/25/2008