Provider First Line Business Practice Location Address:
5755 W ADAMS 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:
90016-2440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-879-9875
Provider Business Practice Location Address Fax Number:
323-879-9876
Provider Enumeration Date:
02/06/2020