Provider First Line Business Practice Location Address:
164 1/2 N AVENUE 23
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:
90031-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-268-4235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2019