Provider First Line Business Practice Location Address:
600 S COMMONWEALTH AVE FL 6
Provider Second Line Business Practice Location Address:
ATTENTION DMH
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-739-5505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2013