Provider First Line Business Practice Location Address:
3694 BARHAM BLVD
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:
90068-1156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-766-1357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2026