Provider First Line Business Practice Location Address:
2419 WORKMAN 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:
90031-2319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-223-9059
Provider Business Practice Location Address Fax Number:
323-223-9684
Provider Enumeration Date:
06/13/2017