Provider First Line Business Practice Location Address:
5314 N FIGUEROA ST UNIT B
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:
90042-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-442-8352
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2025