Provider First Line Business Practice Location Address:
410 S COMMONWEALTH AVE
Provider Second Line Business Practice Location Address:
APT#1
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-453-8753
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2016