Provider First Line Business Practice Location Address:
1611 W. 54TH ST
Provider Second Line Business Practice Location Address:
1611 W. 54TH ST
Provider Business Practice Location Address City Name:
L.A
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-860-1318
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2026