Provider First Line Business Practice Location Address:
1445 S CARMELINA 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:
90025-2504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-357-2068
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2022