Provider First Line Business Practice Location Address:
6757 S HOLT 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:
90056-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-433-7987
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2025