Provider First Line Business Practice Location Address:
4836 W WASHINGTON BLVD
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:
90016-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-937-4506
Provider Business Practice Location Address Fax Number:
323-939-0183
Provider Enumeration Date:
05/26/2017