Provider First Line Business Practice Location Address:
2013 AMES ST
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:
90027-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-428-7634
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2013