Provider First Line Business Practice Location Address:
5503 S MANHATTAN PL
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:
90062-2622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-369-1383
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2024