Provider First Line Business Practice Location Address:
333 S BEAUDRY 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:
90017-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-241-3841
Provider Business Practice Location Address Fax Number:
213-241-3305
Provider Enumeration Date:
10/12/2016