Provider First Line Business Practice Location Address:
1313 W 8TH 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:
90017-4420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-401-1970
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2015