Provider First Line Business Practice Location Address:
1318 E FLORENCE 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:
90001-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-583-4066
Provider Business Practice Location Address Fax Number:
213-554-1387
Provider Enumeration Date:
08/15/2025