Provider First Line Business Practice Location Address:
839 N JUNE 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:
90038-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-842-2654
Provider Business Practice Location Address Fax Number:
888-375-4459
Provider Enumeration Date:
03/05/2026