Provider First Line Business Practice Location Address:
2211 W WASHINGTON 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:
90018-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-731-8800
Provider Business Practice Location Address Fax Number:
323-731-8850
Provider Enumeration Date:
07/26/2008