Provider First Line Business Practice Location Address:
966 S WESTERN AVE
Provider Second Line Business Practice Location Address:
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:
90006-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-734-4800
Provider Business Practice Location Address Fax Number:
373-734-0941
Provider Enumeration Date:
11/28/2005