Provider First Line Business Practice Location Address:
530 E WASHINGTON 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:
90015-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-747-2626
Provider Business Practice Location Address Fax Number:
213-749-7500
Provider Enumeration Date:
08/29/2024