Provider First Line Business Practice Location Address:
2039 BARRY 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:
90025-5310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-804-8848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2025