Provider First Line Business Practice Location Address:
1624 CAMDEN AVE
Provider Second Line Business Practice Location Address:
APT 4
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-3532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-240-0962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2015