Provider First Line Business Practice Location Address:
3760 SANTA ROSALIA DR
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:
90008-3611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-312-4555
Provider Business Practice Location Address Fax Number:
888-814-0207
Provider Enumeration Date:
05/20/2025