Provider First Line Business Practice Location Address:
400 N FORD 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:
90022-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-577-9082
Provider Business Practice Location Address Fax Number:
949-502-8887
Provider Enumeration Date:
06/22/2006