Provider First Line Business Practice Location Address:
1843 1/2 S LA CIENEGA BLVD
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:
90035-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-857-2673
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2023