Provider First Line Business Practice Location Address:
3525 W 8TH ST STE 109
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:
90005-5030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-674-7120
Provider Business Practice Location Address Fax Number:
213-674-7270
Provider Enumeration Date:
09/16/2025