Provider First Line Business Practice Location Address:
2250 ALCAZAR ST
Provider Second Line Business Practice Location Address:
CSC-133
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-9068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-442-3340
Provider Business Practice Location Address Fax Number:
323-442-3351
Provider Enumeration Date:
02/17/2010