Provider First Line Business Practice Location Address:
8836 S VERMONT AVE
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:
90044-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-451-4370
Provider Business Practice Location Address Fax Number:
323-458-8744
Provider Enumeration Date:
03/05/2007