Provider First Line Business Practice Location Address:
3939 TRACY ST
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:
90027-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-671-1400
Provider Business Practice Location Address Fax Number:
323-665-8682
Provider Enumeration Date:
10/19/2011