Provider First Line Business Practice Location Address:
1161 CRENSHAW 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:
90019-3112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-760-1033
Provider Business Practice Location Address Fax Number:
877-234-2675
Provider Enumeration Date:
07/17/2012