Provider First Line Business Practice Location Address:
663 SOUTH BERENDO STREET
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-799-4947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2025