Provider First Line Business Practice Location Address:
200 MEDICAL PLAZA SUITE 420
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-6232
Provider Business Practice Location Address Fax Number:
310-206-3551
Provider Enumeration Date:
03/27/2019