Provider First Line Business Practice Location Address:
4601 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:
90037-2729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-223-5922
Provider Business Practice Location Address Fax Number:
323-897-5334
Provider Enumeration Date:
10/18/2017