Provider First Line Business Practice Location Address:
200 MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-222-8809
Provider Business Practice Location Address Fax Number:
818-222-9553
Provider Enumeration Date:
03/30/2007