Provider First Line Business Practice Location Address:
1818 S. WESTERN AVE
Provider Second Line Business Practice Location Address:
C/O REVIVAL HEALTH CENTER, SUITE #302
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90006-5862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-737-3000
Provider Business Practice Location Address Fax Number:
323-737-3363
Provider Enumeration Date:
09/11/2008