Provider First Line Business Practice Location Address:
4776 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
APT 6
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-356-2134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2014