Provider First Line Business Practice Location Address:
11202 PARMELEE AVE APT 954
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:
90059-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-539-0439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2026