Provider First Line Business Practice Location Address:
5740 YORK BLVD STE B
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:
90042-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-293-6959
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2021