Provider First Line Business Practice Location Address:
925 W 34TH ST ADVANCED PERIODONTOLOGY RESIDENT ROOM 119
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:
90089-0641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-740-2805
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/04/2024