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:
213-249-9388
Provider Business Practice Location Address Fax Number:
213-389-7993
Provider Enumeration Date:
05/01/2018