Provider First Line Business Practice Location Address:
1149 1/2 N NEW HAMPSHIRE 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:
90029-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-686-7368
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2015