Provider First Line Business Practice Location Address:
149 W 22ND ST
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:
90007-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-741-3794
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2024