Provider First Line Business Practice Location Address:
4220 W 3RD ST STE 201
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:
90020-3450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-487-4141
Provider Business Practice Location Address Fax Number:
213-487-0124
Provider Enumeration Date:
10/19/2018