Provider First Line Business Practice Location Address:
1031 W 34TH ST
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:
90089-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-740-9355
Provider Business Practice Location Address Fax Number:
213-740-4960
Provider Enumeration Date:
03/25/2019