Provider First Line Business Practice Location Address:
1670 E 120TH 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:
90059-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-338-2930
Provider Business Practice Location Address Fax Number:
310-631-2934
Provider Enumeration Date:
01/27/2023