Provider First Line Business Practice Location Address:
401 N. LAUREL AVE.
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:
90048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-710-4539
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/28/2024