Provider First Line Business Practice Location Address:
12099 W WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90066-2620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-915-8060
Provider Business Practice Location Address Fax Number:
310-915-8077
Provider Enumeration Date:
11/29/2006