Provider First Line Business Practice Location Address:
2625 MAPLE AVE
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:
90011-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-948-0193
Provider Business Practice Location Address Fax Number:
213-747-1615
Provider Enumeration Date:
12/26/2022