Provider First Line Business Practice Location Address:
2520 W 8TH ST STE 106
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:
90057-3861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-389-2526
Provider Business Practice Location Address Fax Number:
213-389-2506
Provider Enumeration Date:
08/19/2021