Provider First Line Business Practice Location Address:
1200 N STATE ST
Provider Second Line Business Practice Location Address:
ROOM # 9900
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-1029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-7767
Provider Business Practice Location Address Fax Number:
323-226-6958
Provider Enumeration Date:
10/30/2008