Provider First Line Business Practice Location Address:
6622 CRENSHAW BLVD
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:
90043-4102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-468-8404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2023