Provider First Line Business Practice Location Address:
1550 W MANCHESTER 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:
90047-5424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-565-3101
Provider Business Practice Location Address Fax Number:
323-565-3100
Provider Enumeration Date:
05/13/2020