Provider First Line Business Practice Location Address:
201 S ALVARADO
Provider Second Line Business Practice Location Address:
SUITE 515
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:
213-484-7968
Provider Business Practice Location Address Fax Number:
213-484-7886
Provider Enumeration Date:
08/31/2006