Provider First Line Business Practice Location Address:
136 W 84TH 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:
90003-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-537-3881
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2025