Provider First Line Business Practice Location Address:
1326 W IMPERIAL HWY
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:
90044-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-690-7238
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2022