Provider First Line Business Practice Location Address:
248 1/2 S HOBART BLVD
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:
90004-5208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-898-9131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2019