Provider First Line Business Practice Location Address:
2032 MARENGO 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:
90033-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-205-7987
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2023