Provider First Line Business Practice Location Address:
1404 S BURLINGTON 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:
90006-5409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-810-2779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2025