Provider First Line Business Practice Location Address:
1208 W 38TH 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:
90037-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-998-0655
Provider Business Practice Location Address Fax Number:
323-967-7746
Provider Enumeration Date:
03/20/2019