Provider First Line Business Practice Location Address:
2610 S HALM 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:
90034-2424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-319-1128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/16/2025