Provider First Line Business Practice Location Address:
1030 W MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90037-1871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-225-5800
Provider Business Practice Location Address Fax Number:
323-225-5885
Provider Enumeration Date:
07/05/2006