Provider First Line Business Practice Location Address:
5115 W ADAMS 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:
90016-2727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-296-4411
Provider Business Practice Location Address Fax Number:
323-933-5973
Provider Enumeration Date:
06/06/2007