Provider First Line Business Practice Location Address:
201 S ALVARADO ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90057-2320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-484-5377
Provider Business Practice Location Address Fax Number:
213-625-0382
Provider Enumeration Date:
01/09/2010