Provider First Line Business Practice Location Address:
1919 W 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-2222
Provider Business Practice Location Address Fax Number:
213-483-1711
Provider Enumeration Date:
07/26/2016