Provider First Line Business Practice Location Address: 
550 S VERMONT AVE
    Provider Second Line Business Practice Location Address: 
    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: 
213-430-6700
    Provider Business Practice Location Address Fax Number: 
213-895-6266
    Provider Enumeration Date: 
02/14/2007