Provider First Line Business Practice Location Address:
1848 N 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:
90026-1781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-663-0465
Provider Business Practice Location Address Fax Number:
323-953-6718
Provider Enumeration Date:
09/14/2006