Provider First Line Business Practice Location Address:
2120 W 8TH ST
Provider Second Line Business Practice Location Address:
UNIT 310
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-4019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-603-0758
Provider Business Practice Location Address Fax Number:
213-388-9608
Provider Enumeration Date:
08/12/2015