Provider First Line Business Practice Location Address:
1622 ALVIRA 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:
90035-4518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-219-2060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2018