Provider First Line Business Practice Location Address:
12920 S FIGUEROA ST STE A
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:
90061-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-323-2629
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2017