Provider First Line Business Practice Location Address:
2121 S SAN PEDRO ST
Provider Second Line Business Practice Location Address:
UNIT E
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90011-1160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-747-0300
Provider Business Practice Location Address Fax Number:
213-746-0044
Provider Enumeration Date:
08/01/2014