Provider First Line Business Practice Location Address:
3520 W 21ST 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:
90018-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-527-8213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2023