Provider First Line Business Practice Location Address:
2116 S CENTRAL 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:
90011-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-493-4664
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2024