Provider First Line Business Practice Location Address:
1513 S GRAND AVE STE 306
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:
90015-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-246-2422
Provider Business Practice Location Address Fax Number:
213-246-2019
Provider Enumeration Date:
12/04/2019