Provider First Line Business Practice Location Address:
1000 VETERAN AVE
Provider Second Line Business Practice Location Address:
REHAB CENTER 32-59
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:
310-825-7992
Provider Business Practice Location Address Fax Number:
310-206-8606
Provider Enumeration Date:
10/25/2005