Provider First Line Business Practice Location Address:
1525 N ALVARADO ST UNIT 26193
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:
90026-7414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-267-5525
Provider Business Practice Location Address Fax Number:
213-374-1100
Provider Enumeration Date:
03/23/2018