Provider First Line Business Practice Location Address:
231 W VERNON AVE STE 104
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:
90037-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-6271
Provider Business Practice Location Address Fax Number:
323-233-8196
Provider Enumeration Date:
09/22/2006