Provider First Line Business Practice Location Address:
127 S. SAN VICENTE BLVD
Provider Second Line Business Practice Location Address:
AHSP, A3600
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:
310-423-1153
Provider Business Practice Location Address Fax Number:
310-423-6795
Provider Enumeration Date:
12/14/2005