Provider First Line Business Practice Location Address:
226 S. AVE. 52
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:
90042-4504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-884-2599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2015