Provider First Line Business Practice Location Address:
420 E 3RD ST STE 110
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:
90013-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-935-8795
Provider Business Practice Location Address Fax Number:
213-935-8786
Provider Enumeration Date:
07/08/2016