Provider First Line Business Practice Location Address:
545 S BREED 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:
90033-4309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-807-4168
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2016