Provider First Line Business Practice Location Address:
2642 S BEDFORD 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:
90034-2414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-448-6833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2021