Provider First Line Business Practice Location Address:
731 1/2 N ARDMORE 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:
90029-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-425-6872
Provider Business Practice Location Address Fax Number:
213-989-0154
Provider Enumeration Date:
11/11/2015