Provider First Line Business Practice Location Address:
608 N AVENUE 50
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:
90042-3292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-465-3607
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2017