Provider First Line Business Practice Location Address:
670 S WESTERN AVE
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:
90005-3024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-6207
Provider Business Practice Location Address Fax Number:
213-383-9703
Provider Enumeration Date:
04/16/2016