Provider First Line Business Practice Location Address:
450 BAUCHET ST.
Provider Second Line Business Practice Location Address:
ROOM E873
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-893-5470
Provider Business Practice Location Address Fax Number:
213-346-9851
Provider Enumeration Date:
03/25/2015