Provider First Line Business Practice Location Address:
1100 N. STATE STREET
Provider Second Line Business Practice Location Address:
CLINIC TOWER, A6E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-1000
Provider Business Practice Location Address Fax Number:
507-607-8735
Provider Enumeration Date:
03/25/2015