Provider First Line Business Practice Location Address:
1037 E 34TH ST
Provider Second Line Business Practice Location Address:
SOUTH CENTRAL SEA
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90011-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-9100
Provider Business Practice Location Address Fax Number:
323-233-2489
Provider Enumeration Date:
04/24/2007