Provider First Line Business Practice Location Address:
2051 MARENGO 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:
90033-1352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-5669
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2015