Provider First Line Business Practice Location Address:
1017 W 50TH ST
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:
90037-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-758-4670
Provider Business Practice Location Address Fax Number:
323-758-4011
Provider Enumeration Date:
07/15/2014