Provider First Line Business Practice Location Address:
5927 LINDENHURST 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:
90036-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-366-1048
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2025