Provider First Line Business Practice Location Address:
2500 W 8TH ST
Provider Second Line Business Practice Location Address:
106
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-3860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-381-2827
Provider Business Practice Location Address Fax Number:
213-381-2829
Provider Enumeration Date:
04/20/2017