Provider First Line Business Practice Location Address:
3200 W TEMPLE ST APT 310
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:
90026-7374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-312-7669
Provider Business Practice Location Address Fax Number:
213-312-7669
Provider Enumeration Date:
02/11/2026