Provider First Line Business Practice Location Address:
470 E 3RD ST STE A&B
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:
90013-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-626-6411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2022