Provider First Line Business Practice Location Address:
702 S SERRANO AVE APT 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:
90005-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-691-8365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2022