Provider First Line Business Practice Location Address:
132 S BEAUDRY 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:
90012-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-977-9300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/29/2023