Provider First Line Business Practice Location Address:
919 S DUNSMUIR 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:
90036-4729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-484-6223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2022