Provider First Line Business Practice Location Address:
402 E 2ND 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:
90012-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-680-4011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2020