Provider First Line Business Practice Location Address:
5869 MELROSE AVE
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:
90038-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-317-7821
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/09/2025