Provider First Line Business Practice Location Address:
12226 S WESTERN 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:
90047-5240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-600-6000
Provider Business Practice Location Address Fax Number:
323-756-1392
Provider Enumeration Date:
12/05/2019