Provider First Line Business Practice Location Address:
231 W VERNON AVE
Provider Second Line Business Practice Location Address:
# 103
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90037-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-6843
Provider Business Practice Location Address Fax Number:
323-233-7861
Provider Enumeration Date:
02/20/2007