Provider First Line Business Practice Location Address:
169 S ALVARADO ST
Provider Second Line Business Practice Location Address:
SUITE # 103
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-353-4723
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2009