Provider First Line Business Practice Location Address:
1670 EAST 120 TH STREET ,
Provider Second Line Business Practice Location Address:
MARTIN LUTHER KING JR. PHARMACY
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90059-3019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-338-1930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2014