Provider First Line Business Practice Location Address:
981 S CATALINA ST APT 2
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:
90006-1530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-985-6445
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2015