Provider First Line Business Practice Location Address:
10221 COMPTON 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:
90002-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-5100
Provider Business Practice Location Address Fax Number:
310-669-9482
Provider Enumeration Date:
11/23/2011