Provider First Line Business Practice Location Address:
3000 W 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90020-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-352-1343
Provider Business Practice Location Address Fax Number:
213-352-1343
Provider Enumeration Date:
03/04/2015