Provider First Line Business Practice Location Address:
3663 W 6TH ST
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-3049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-7500
Provider Business Practice Location Address Fax Number:
213-383-6910
Provider Enumeration Date:
07/28/2014