Provider First Line Business Practice Location Address:
1428 S SHENANDOAH 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:
90035-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-422-1459
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2023