Provider First Line Business Practice Location Address:
130 S ALVARADO ST
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:
90057-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-484-9660
Provider Business Practice Location Address Fax Number:
213-484-8317
Provider Enumeration Date:
02/22/2007