Provider First Line Business Practice Location Address:
1157 LEMOYNE 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:
90026-3206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-6335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2022