Provider First Line Business Practice Location Address: 
3727 W 6TH ST STE 300
    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: 
90020-5108
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
213-365-7400
    Provider Business Practice Location Address Fax Number: 
213-201-3993
    Provider Enumeration Date: 
08/25/2015