Provider First Line Business Practice Location Address:
1440 E 41ST 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:
90011-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-676-5622
Provider Business Practice Location Address Fax Number:
232-231-8771
Provider Enumeration Date:
03/24/2022