Provider First Line Business Practice Location Address:
201 S ALVARADO ST #717
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:
90057-2390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-989-6959
Provider Business Practice Location Address Fax Number:
213-989-2012
Provider Enumeration Date:
09/21/2006