Provider First Line Business Practice Location Address:
1817 GARFIELD PL APT 9
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:
90028-6699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-465-9302
Provider Business Practice Location Address Fax Number:
213-465-9302
Provider Enumeration Date:
02/09/2026