Provider First Line Business Practice Location Address:
600 S COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
SUITE 800 NFP-LA PROGRAM
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-441-9416
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2012