Provider First Line Business Practice Location Address:
200 MED PLAZA SUITE 365
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:
90095-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-2448
Provider Business Practice Location Address Fax Number:
310-794-6553
Provider Enumeration Date:
12/30/2013