Provider First Line Business Practice Location Address:
5801 S FIGUEROA 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:
90003-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-623-8684
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2025