Provider First Line Business Practice Location Address: 
3580 WILSHIRE BLVD
    Provider Second Line Business Practice Location Address: 
800
    Provider Business Practice Location Address City Name: 
LOS ANGELES
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
90010-2501
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
213-637-5000
    Provider Business Practice Location Address Fax Number: 
213-637-5001
    Provider Enumeration Date: 
07/29/2008