Provider First Line Business Practice Location Address:
1607 S HOLT 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:
90035-3612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-666-9229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2024