Provider First Line Business Practice Location Address:
3000 W 6TH ST STE 302
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:
90020-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-973-0045
Provider Business Practice Location Address Fax Number:
213-257-8657
Provider Enumeration Date:
06/15/2026