Provider First Line Business Practice Location Address:
2200 W 3RD 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:
90057-1932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-202-7170
Provider Business Practice Location Address Fax Number:
562-967-2352
Provider Enumeration Date:
03/16/2022