Provider First Line Business Practice Location Address:
6147 S HARVARD BLVD
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:
90047-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-944-5525
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2023