Provider First Line Business Practice Location Address:
1005 S CENTRAL AVE
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:
90021-2039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-533-1050
Provider Business Practice Location Address Fax Number:
213-533-1057
Provider Enumeration Date:
04/12/2011