Provider First Line Business Practice Location Address:
1555 WEST 110TH ST
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:
90047-1220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-541-1600
Provider Business Practice Location Address Fax Number:
323-541-1661
Provider Enumeration Date:
01/21/2014