Provider First Line Business Practice Location Address:
1343 S CARMELINA AVE
Provider Second Line Business Practice Location Address:
APT 1A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-1987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-341-6768
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2015