Provider First Line Business Practice Location Address:
1636 S SPAULDING AVE
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:
90019-3844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-469-2769
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2024