Provider First Line Business Practice Location Address:
349 S LAFAYETTE PARK PLACE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES CA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-840-7247
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2025