Provider First Line Business Practice Location Address:
621 W ADAMS BLVD
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:
90007-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-819-5713
Provider Business Practice Location Address Fax Number:
951-944-2351
Provider Enumeration Date:
10/06/2025