Provider First Line Business Practice Location Address:
200 MEDICAL PLAZA
Provider Second Line Business Practice Location Address:
#530
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90074
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-794-1503
Provider Business Practice Location Address Fax Number:
310-267-1899
Provider Enumeration Date:
10/17/2006