Provider First Line Business Practice Location Address:
826 1/2 S PLYMOUTH 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:
90005-3896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-658-4005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/13/2025