Provider First Line Business Practice Location Address:
1701 E CESAR E CHAVEZ AVE STE 128
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:
90033-2483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-223-2338
Provider Business Practice Location Address Fax Number:
323-225-2340
Provider Enumeration Date:
01/08/2024