Provider First Line Business Practice Location Address:
12021 S. WILMINGTON AVENUE
Provider Second Line Business Practice Location Address:
MARTIN LUTHER KING. ASC.
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-668-5201
Provider Business Practice Location Address Fax Number:
310-638-8193
Provider Enumeration Date:
04/27/2006