Provider First Line Business Practice Location Address:
637 LUCAS AVE STE 609
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:
90017-1997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-482-5226
Provider Business Practice Location Address Fax Number:
213-482-5040
Provider Enumeration Date:
08/26/2014