Provider First Line Business Practice Location Address:
5125 CRENSHAW 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:
90043-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-750-2400
Provider Business Practice Location Address Fax Number:
323-825-5660
Provider Enumeration Date:
08/18/2014