Provider First Line Business Practice Location Address:
2120 W 8TH ST STE 102
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:
90057-4081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-382-2700
Provider Business Practice Location Address Fax Number:
213-382-5077
Provider Enumeration Date:
03/12/2021