Provider First Line Business Practice Location Address:
2409 N BROADWAY, LOS ANGELES, CA 90031
Provider Second Line Business Practice Location Address:
90031
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-225-8038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2023