Provider First Line Business Practice Location Address:
500 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:
90013-2102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-728-8523
Provider Business Practice Location Address Fax Number:
805-587-8094
Provider Enumeration Date:
04/30/2025