Provider First Line Business Practice Location Address:
127 S. VICENTE AHSP 3106
Provider Second Line Business Practice Location Address:
127 S. VICENTE BLVD, AHSP A3200-06
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-247-3658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2014