Provider First Line Business Practice Location Address: 
8019 S. COMPTON 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: 
90001
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
323-586-7333
    Provider Business Practice Location Address Fax Number: 
323-588-5622
    Provider Enumeration Date: 
07/19/2011