Provider First Line Business Practice Location Address:
903 SOUTH CRENSHAW BLVD.
Provider Second Line Business Practice Location Address:
SUITE 200
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-937-3333
Provider Business Practice Location Address Fax Number:
323-937-4933
Provider Enumeration Date:
05/01/2009