Provider First Line Business Practice Location Address:
2705 W 8TH ST STE B
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:
90005-1286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-800-4720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2015