Provider First Line Business Practice Location Address:
2020 E 1ST 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:
90033-3916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-257-1056
Provider Business Practice Location Address Fax Number:
323-529-0200
Provider Enumeration Date:
12/09/2024