Provider First Line Business Practice Location Address:
7501 OSAGE 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:
90045-1744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-262-8968
Provider Business Practice Location Address Fax Number:
424-309-9165
Provider Enumeration Date:
04/07/2026