Provider First Line Business Practice Location Address:
201 S ALVARADO STREET
Provider Second Line Business Practice Location Address:
SUITE 402
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:
213-484-2919
Provider Business Practice Location Address Fax Number:
213-484-2132
Provider Enumeration Date:
04/21/2016