Provider First Line Business Practice Location Address:
520 W 48TH 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:
90037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-359-4837
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2024