Provider First Line Business Practice Location Address:
300 MEDICAL PLZ
Provider Second Line Business Practice Location Address:
SUITE 2339
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:
213-399-4163
Provider Business Practice Location Address Fax Number:
213-477-2280
Provider Enumeration Date:
12/08/2008