Provider First Line Business Practice Location Address:
1218 S HICKS 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:
90023-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-432-7270
Provider Business Practice Location Address Fax Number:
323-544-6475
Provider Enumeration Date:
10/22/2026