Provider First Line Business Practice Location Address:
2010 ZONAL AVENUE, MEDICAL VILLAGE
Provider Second Line Business Practice Location Address:
OPD 5 WEST
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:
323-226-2200
Provider Business Practice Location Address Fax Number:
323-226-3971
Provider Enumeration Date:
09/20/2006