Provider First Line Business Practice Location Address:
3251 W 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 418
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-5023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-5301
Provider Business Practice Location Address Fax Number:
213-385-5343
Provider Enumeration Date:
02/25/2016