Provider First Line Business Practice Location Address:
2411 N BROADWAY
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:
90031-2218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-987-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2019