Provider First Line Business Practice Location Address:
942 S ATLANTIC BLVD
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:
90022-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-263-9700
Provider Business Practice Location Address Fax Number:
323-263-8042
Provider Enumeration Date:
08/01/2023