Provider First Line Business Practice Location Address:
1575 W 2ND ST RM 364
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:
90026-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-487-0600
Provider Business Practice Location Address Fax Number:
213-487-0500
Provider Enumeration Date:
05/05/2021