Provider First Line Business Practice Location Address:
4801 2ND 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:
90043-1901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-295-1020
Provider Business Practice Location Address Fax Number:
323-298-1318
Provider Enumeration Date:
04/05/2007