Provider First Line Business Practice Location Address:
1231 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:
90006-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-889-8914
Provider Business Practice Location Address Fax Number:
310-859-2298
Provider Enumeration Date:
10/12/2026