Provider First Line Business Practice Location Address:
150 MEDICAL PLZ
Provider Second Line Business Practice Location Address:
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:
310-267-9195
Provider Business Practice Location Address Fax Number:
310-267-3502
Provider Enumeration Date:
06/07/2012