Provider First Line Business Practice Location Address:
1931 PREUSS RD
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:
90034-1106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-390-0799
Provider Business Practice Location Address Fax Number:
323-544-6493
Provider Enumeration Date:
01/02/2024