Provider First Line Business Practice Location Address:
8880 S BROADWAY
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:
90003-3635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-750-1196
Provider Business Practice Location Address Fax Number:
323-750-0330
Provider Enumeration Date:
12/12/2006