Provider First Line Business Practice Location Address:
1968 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:
90018-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-774-7711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2008