Provider First Line Business Practice Location Address:
3335 FOLSOM 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:
90063-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-200-8305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2019