Provider First Line Business Practice Location Address:
166 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:
90057-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-496-4976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2022