Provider First Line Business Practice Location Address:
866 N VERMONT AVE
Provider Second Line Business Practice Location Address:
4
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90029-3587
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-667-1008
Provider Business Practice Location Address Fax Number:
323-667-1141
Provider Enumeration Date:
09/11/2008