Provider First Line Business Practice Location Address:
420 E 3RD ST STE 106
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:
90013-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-253-5999
Provider Business Practice Location Address Fax Number:
213-253-5970
Provider Enumeration Date:
02/26/2019