Provider First Line Business Practice Location Address:
234 S KENMORE AVE
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:
90004-5654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-291-7022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2021