Provider First Line Business Practice Location Address:
521 S SAN PEDRO 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:
90013-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-623-2916
Provider Business Practice Location Address Fax Number:
213-622-1801
Provider Enumeration Date:
11/17/2014