Provider First Line Business Practice Location Address:
1211 N VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90029-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-664-4114
Provider Business Practice Location Address Fax Number:
323-664-4044
Provider Enumeration Date:
11/24/2009