Provider First Line Business Practice Location Address:
1354 N HIGHLAND 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:
90028-7609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-655-4105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2018