Provider First Line Business Practice Location Address:
1947 CLINTON 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:
90026-4136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-821-3111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2023