Provider First Line Business Practice Location Address:
2160 W ADAMS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CALIFORNIA
Provider Business Practice Location Address Postal Code:
90111
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
323-432-5185
Provider Business Practice Location Address Fax Number:
323-432-5086
Provider Enumeration Date:
03/28/2007