Provider First Line Business Practice Location Address:
149 S MEDNIK AVE # 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:
90022-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-981-9714
Provider Business Practice Location Address Fax Number:
323-981-9715
Provider Enumeration Date:
08/21/2019