Provider First Line Business Practice Location Address:
339 S ARDMORE AVE APT 320
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:
90020-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-819-3291
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2024