Provider First Line Business Practice Location Address:
3145 S CANFIELD AVE
Provider Second Line Business Practice Location Address:
APT. 11
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90034-4368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-621-1087
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2015