Provider First Line Business Practice Location Address:
123 S ALVARADO 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:
90057-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-201-2765
Provider Business Practice Location Address Fax Number:
213-989-7702
Provider Enumeration Date:
04/24/2012