Provider First Line Business Practice Location Address:
2035 CAMFIELD 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:
90040-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-597-2895
Provider Business Practice Location Address Fax Number:
323-853-6935
Provider Enumeration Date:
04/24/2024