Provider First Line Business Practice Location Address:
1227 E 25TH 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:
90011-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-926-7454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2023