Provider First Line Business Practice Location Address:
2107 S SAN PEDRO 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:
90011-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-441-7771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2021