Provider First Line Business Practice Location Address:
104 W 7TH ST STE 2
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:
90014-1906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-688-2828
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2025