Provider First Line Business Practice Location Address:
515 COLUMBIA AVE
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:
90017-1209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-553-1884
Provider Business Practice Location Address Fax Number:
213-236-9662
Provider Enumeration Date:
10/04/2017