Provider First Line Business Practice Location Address:
637 LUCAS AVE
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:
90017-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-977-2360
Provider Business Practice Location Address Fax Number:
213-977-2365
Provider Enumeration Date:
03/27/2014