Provider First Line Business Practice Location Address:
833 ALPINE STREET
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:
90012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-680-0746
Provider Business Practice Location Address Fax Number:
213-680-1037
Provider Enumeration Date:
08/28/2015