Provider First Line Business Practice Location Address:
6612 3RD 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:
90043-4550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-815-3320
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2020