Provider First Line Business Practice Location Address:
2525 N CATALINA 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:
90027-1132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-663-4595
Provider Business Practice Location Address Fax Number:
323-663-0120
Provider Enumeration Date:
03/18/2013