Provider First Line Business Practice Location Address:
2819 WEST 42ND STREET
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:
90008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-422-1154
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2020