Provider First Line Business Practice Location Address:
221 N ARDMORE 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:
90004-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-381-3626
Provider Business Practice Location Address Fax Number:
213-380-8923
Provider Enumeration Date:
09/11/2015