Provider First Line Business Practice Location Address:
1015 S ORANGE GROVE 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:
90019-6510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-933-8271
Provider Business Practice Location Address Fax Number:
562-202-5009
Provider Enumeration Date:
08/07/2023