Provider First Line Business Practice Location Address:
246 E 47TH 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:
90011-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-238-6500
Provider Business Practice Location Address Fax Number:
323-897-5479
Provider Enumeration Date:
12/16/2019