Provider First Line Business Practice Location Address:
507 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:
90057-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-529-4060
Provider Business Practice Location Address Fax Number:
213-529-4062
Provider Enumeration Date:
10/04/2022