Provider First Line Business Practice Location Address:
1539 E IMPERIAL HWY UNIT 33
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:
90059-1831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
769-328-4922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2026