Provider First Line Business Practice Location Address:
1130 1/2 S HOOVER ST
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:
90006-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-376-2870
Provider Business Practice Location Address Fax Number:
860-955-6471
Provider Enumeration Date:
04/16/2014