Provider First Line Business Practice Location Address:
12470 W WASHINGTON 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:
90066-5512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-814-9116
Provider Business Practice Location Address Fax Number:
818-337-1459
Provider Enumeration Date:
05/28/2022