Provider First Line Business Practice Location Address:
325 E. 7TH STREET
Provider Second Line Business Practice Location Address:
ROOM 101
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90014-9001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-425-3131
Provider Business Practice Location Address Fax Number:
833-591-0218
Provider Enumeration Date:
03/05/2020