Provider First Line Business Practice Location Address:
3077 UNIVERSITY AVE STE 105
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:
90007-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-480-7129
Provider Business Practice Location Address Fax Number:
805-584-9651
Provider Enumeration Date:
12/19/2015