Provider First Line Business Practice Location Address:
216 1/2 W 83RD 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:
90003-2811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-245-9070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/27/2022