Provider First Line Business Practice Location Address:
817 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:
90005-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-0029
Provider Business Practice Location Address Fax Number:
213-385-5619
Provider Enumeration Date:
02/29/2016