Provider First Line Business Practice Location Address:
1525 N ALVARADO ST UNIT 26083
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:
90026-7407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-224-9691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2019