Provider First Line Business Practice Location Address:
1260 S ATLANTIC 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:
90022-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-780-1838
Provider Business Practice Location Address Fax Number:
323-780-7823
Provider Enumeration Date:
09/22/2005