Provider First Line Business Practice Location Address:
600 S COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-739-2348
Provider Business Practice Location Address Fax Number:
213-738-6521
Provider Enumeration Date:
02/02/2016