Provider First Line Business Practice Location Address:
2909 S CATALINA 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:
90007-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-338-0130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2023