Provider First Line Business Practice Location Address:
1816 S FIGUEROA 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:
90015-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-763-0306
Provider Business Practice Location Address Fax Number:
213-746-7620
Provider Enumeration Date:
12/17/2018