Provider First Line Business Practice Location Address:
6360 W 5TH 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:
90048-4718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-549-9479
Provider Business Practice Location Address Fax Number:
323-549-9171
Provider Enumeration Date:
10/16/2017