Provider First Line Business Practice Location Address:
1540 ALCAZAR STREET
Provider Second Line Business Practice Location Address:
CHP 207
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90089-9007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-409-7346
Provider Business Practice Location Address Fax Number:
323-226-4051
Provider Enumeration Date:
03/20/2021