Provider First Line Business Practice Location Address:
4425 S CENTRAL 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:
90011-3629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-908-4200
Provider Business Practice Location Address Fax Number:
323-985-9940
Provider Enumeration Date:
03/06/2007