Provider First Line Business Practice Location Address:
746 S ALVARADO ST
Provider Second Line Business Practice Location Address:
STE #8 DE LA CRUZ DENTAL AP INC
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-989-6859
Provider Business Practice Location Address Fax Number:
213-989-6933
Provider Enumeration Date:
03/18/2008