Provider First Line Business Practice Location Address:
1557 E FLORENCE AVE
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:
90001-2597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-584-1490
Provider Business Practice Location Address Fax Number:
323-584-1489
Provider Enumeration Date:
02/23/2023