Provider First Line Business Practice Location Address:
3743 S LABREA AVENUE
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:
90016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-329-9005
Provider Business Practice Location Address Fax Number:
323-294-3949
Provider Enumeration Date:
03/30/2017