Provider First Line Business Practice Location Address:
4443 AMBROSE 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:
90027-2114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-600-8288
Provider Business Practice Location Address Fax Number:
213-289-1180
Provider Enumeration Date:
02/01/2019