Provider First Line Business Practice Location Address:
2065 VENICE BLVD
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:
90006-5222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-874-4100
Provider Business Practice Location Address Fax Number:
323-766-9500
Provider Enumeration Date:
03/31/2008