Provider First Line Business Practice Location Address:
3767 1/2 HUBBARD 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:
90023-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-316-4069
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2014