Provider First Line Business Practice Location Address:
128 N ARDMORE AVE
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:
90004-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-674-7046
Provider Business Practice Location Address Fax Number:
213-674-7046
Provider Enumeration Date:
07/12/2015