Provider First Line Business Practice Location Address:
5310 FOUNTAIN AVE
Provider Second Line Business Practice Location Address:
REHAB DEPT
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90029-1005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-227-1483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2017