Provider First Line Business Practice Location Address:
1263 S SOTO 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:
90023-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-395-7100
Provider Business Practice Location Address Fax Number:
626-395-7270
Provider Enumeration Date:
10/11/2019