Provider First Line Business Practice Location Address:
200 MED PLAZA
Provider Second Line Business Practice Location Address:
# 365,420,120
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-995-8044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2012