Provider First Line Business Practice Location Address:
200 MEDICAL PLAZA SUITE 265
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:
90095-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-206-6581
Provider Business Practice Location Address Fax Number:
310-206-8616
Provider Enumeration Date:
11/02/2017