Provider First Line Business Practice Location Address:
2829 S GRAND AVE FL 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:
90007-3304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-609-7180
Provider Business Practice Location Address Fax Number:
213-744-3999
Provider Enumeration Date:
01/20/2023