Provider First Line Business Practice Location Address:
1510 S POINT VIEW 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:
90035-3912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-545-1257
Provider Business Practice Location Address Fax Number:
310-974-4972
Provider Enumeration Date:
02/16/2026