Provider First Line Business Practice Location Address:
646 SOUTH BARRANCA AVE
Provider Second Line Business Practice Location Address:
ROOM A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-297-0905
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2025