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:
323-262-9222
Provider Business Practice Location Address Fax Number:
323-262-9261
Provider Enumeration Date:
09/25/2007