Provider First Line Business Practice Location Address:
1619 1/4 N MARTEL 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:
90046-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-319-5606
Provider Business Practice Location Address Fax Number:
323-319-5606
Provider Enumeration Date:
04/29/2024