Provider First Line Business Practice Location Address:
5619 N FIGUEROA ST
Provider Second Line Business Practice Location Address:
216
Provider Business Practice Location Address City Name:
LOS ANGELAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-267-0142
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2017