Provider First Line Business Practice Location Address:
936 1/2 E 55TH 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:
90011-5352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-891-0990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2022