Provider First Line Business Practice Location Address:
1800 12TH 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:
90019-6023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-734-1705
Provider Business Practice Location Address Fax Number:
323-732-3411
Provider Enumeration Date:
06/06/2008