Provider First Line Business Practice Location Address:
640 MAPLE AVE
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:
90014-2212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-996-7000
Provider Business Practice Location Address Fax Number:
213-996-7000
Provider Enumeration Date:
09/27/2010