Provider First Line Business Practice Location Address:
201 S ALVARADO
Provider Second Line Business Practice Location Address:
SUITE 612
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-484-7074
Provider Business Practice Location Address Fax Number:
213-484-7075
Provider Enumeration Date:
10/02/2006