Provider First Line Business Practice Location Address:
4849 CIVIC CENTER WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-980-2752
Provider Business Practice Location Address Fax Number:
323-780-8418
Provider Enumeration Date:
01/31/2008