Provider First Line Business Practice Location Address:
1133 S VERMONT AVE
Provider Second Line Business Practice Location Address:
STE 17
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90006-2764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-480-6700
Provider Business Practice Location Address Fax Number:
213-480-6704
Provider Enumeration Date:
10/17/2006