Provider First Line Business Practice Location Address:
1760 EAST 120TH STREET
Provider Second Line Business Practice Location Address:
MARTIN LUTHER KING OUTPATIENT CENTER.
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-357-3439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006