Provider First Line Business Practice Location Address:
5020 EAST WASHINGTON BLVD.
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:
90040-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-260-7900
Provider Business Practice Location Address Fax Number:
323-266-1087
Provider Enumeration Date:
10/04/2006