Provider First Line Business Practice Location Address:
470 E 3RD 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:
90013-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-620-5712
Provider Business Practice Location Address Fax Number:
213-621-4155
Provider Enumeration Date:
09/05/2018