Provider First Line Business Practice Location Address:
4141 VERDUGO RD
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:
90065-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-760-5144
Provider Business Practice Location Address Fax Number:
818-655-0556
Provider Enumeration Date:
07/12/2022