Provider First Line Business Practice Location Address:
8725 S SAN PEDRO 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:
90003-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-996-1989
Provider Business Practice Location Address Fax Number:
443-681-3434
Provider Enumeration Date:
02/23/2022