Provider First Line Business Practice Location Address:
546 N 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:
90036-1808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-720-2171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2023