Provider First Line Business Practice Location Address:
1940 S BEDFORD 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:
90034-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-946-9063
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2024