Provider First Line Business Practice Location Address:
801 W 70TH ST
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:
90044-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-332-2280
Provider Business Practice Location Address Fax Number:
323-588-3336
Provider Enumeration Date:
07/20/2026