Provider First Line Business Practice Location Address:
741 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:
90057-4021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-413-6666
Provider Business Practice Location Address Fax Number:
215-351-9504
Provider Enumeration Date:
05/27/2014