Provider First Line Business Practice Location Address:
2250 ALCAZAR ST
Provider Second Line Business Practice Location Address:
CSC 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:
90089-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-2872
Provider Business Practice Location Address Fax Number:
323-442-2082
Provider Enumeration Date:
09/14/2021