Provider First Line Business Practice Location Address:
1100 N. STATE STREET
Provider Second Line Business Practice Location Address:
CLINIC TOWER/A2B
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:
323-409-5040
Provider Business Practice Location Address Fax Number:
323-441-4339
Provider Enumeration Date:
07/14/2017