Provider First Line Business Practice Location Address:
2000 W 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:
90018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-212-5775
Provider Business Practice Location Address Fax Number:
226-840-9359
Provider Enumeration Date:
04/28/2015