Provider First Line Business Practice Location Address:
1812 S NEW ENGLAND 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:
90006-5314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-713-8180
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2024