Provider First Line Business Practice Location Address:
1607 N EL CENTRO AVE STE 22
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:
90028-6430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-450-9531
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2020