Provider First Line Business Practice Location Address:
711 N ALVARADO ST
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90026-4076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-999-7011
Provider Business Practice Location Address Fax Number:
213-483-0047
Provider Enumeration Date:
11/02/2006