Provider First Line Business Practice Location Address:
3002 MIDVALE AVE STE 210
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:
90034-3418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-424-5589
Provider Business Practice Location Address Fax Number:
888-614-2814
Provider Enumeration Date:
11/24/2021