Provider First Line Business Practice Location Address:
1458 S SAN PEDRO ST # L19
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:
90015-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-536-5349
Provider Business Practice Location Address Fax Number:
213-289-2631
Provider Enumeration Date:
08/19/2019