Provider First Line Business Practice Location Address:
1233 N VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE #4
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90029-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-661-0800
Provider Business Practice Location Address Fax Number:
323-661-3559
Provider Enumeration Date:
02/12/2007