Provider First Line Business Practice Location Address:
955 N VIGNES 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:
90012-2927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-215-9238
Provider Business Practice Location Address Fax Number:
213-625-0079
Provider Enumeration Date:
11/03/2021