Provider First Line Business Practice Location Address:
355 W MANCHESTER 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:
90003-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-751-4100
Provider Business Practice Location Address Fax Number:
323-751-2853
Provider Enumeration Date:
01/30/2007