Provider First Line Business Practice Location Address:
1850 IVAR AVE
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:
90028-5008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-700-2661
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2018