Provider First Line Business Practice Location Address:
1617 N EL CENTRO AVE
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90028-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-464-1659
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2015