Provider First Line Business Practice Location Address:
702 W 49TH 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:
90037-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-332-2428
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2026