Provider First Line Business Practice Location Address:
1702 S HOOVER ST
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:
90006-4962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-8275
Provider Business Practice Location Address Fax Number:
213-205-8415
Provider Enumeration Date:
01/27/2026