Provider First Line Business Practice Location Address:
2820 GLENDALE BLVD STE 3
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:
90039-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-700-3940
Provider Business Practice Location Address Fax Number:
213-306-5650
Provider Enumeration Date:
11/02/2021