Provider First Line Business Practice Location Address:
1100 N STATE ST
Provider Second Line Business Practice Location Address:
CLINIC TOWERS A4A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90033-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-7575
Provider Business Practice Location Address Fax Number:
323-441-8145
Provider Enumeration Date:
12/16/2010