Provider First Line Business Practice Location Address:
8024 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:
90044-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-753-3193
Provider Business Practice Location Address Fax Number:
323-753-0216
Provider Enumeration Date:
07/29/2009