Provider First Line Business Practice Location Address:
900 N 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:
90026-3105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-483-7669
Provider Business Practice Location Address Fax Number:
213-483-7664
Provider Enumeration Date:
05/24/2019