Provider First Line Business Practice Location Address:
4969 W ADAMS 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:
90016-2849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-373-1870
Provider Business Practice Location Address Fax Number:
323-212-3511
Provider Enumeration Date:
05/01/2007