Provider First Line Business Practice Location Address:
1200 NORTH STATE
Provider Second Line Business Practice Location Address:
CT-2B 300 LAC-USC
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-9985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-226-6225
Provider Business Practice Location Address Fax Number:
323-441-8123
Provider Enumeration Date:
06/21/2012