Provider First Line Business Practice Location Address:
3671 W 6TH ST STE B
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:
90020-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-375-7511
Provider Business Practice Location Address Fax Number:
213-375-7232
Provider Enumeration Date:
04/09/2018