Provider First Line Business Practice Location Address:
123 S EDINBURGH 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:
90048-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-447-8199
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2024