Provider First Line Business Practice Location Address:
4125 VERDUGO RD STE A
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:
90065-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-962-6767
Provider Business Practice Location Address Fax Number:
602-968-6790
Provider Enumeration Date:
03/31/2023