Provider First Line Business Practice Location Address:
6218 COMPTON 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:
90001-1795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-793-8396
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/18/2025