Provider First Line Business Practice Location Address:
550 S VERMONT AVE
Provider Second Line Business Practice Location Address:
EOB / PMRT SA3,10TH 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:
90020-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-258-2004
Provider Business Practice Location Address Fax Number:
626-455-0623
Provider Enumeration Date:
10/23/2006