Provider First Line Business Practice Location Address:
6345 WOOSTER AVE
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:
90056-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-215-7565
Provider Business Practice Location Address Fax Number:
323-754-8832
Provider Enumeration Date:
03/29/2023