Provider First Line Business Practice Location Address:
711 NORTH ALVARADO ST. SUITE 101
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:
90026-4016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-484-8786
Provider Business Practice Location Address Fax Number:
213-484-8783
Provider Enumeration Date:
08/27/2012