Provider First Line Business Practice Location Address:
1107 S ALVARADO ST STE 103
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:
90006-4161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-895-2711
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2014