Provider First Line Business Practice Location Address:
1101 S VERMONT AVE STE 207
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:
90006-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-365-1268
Provider Business Practice Location Address Fax Number:
213-365-1269
Provider Enumeration Date:
03/23/2012