Provider First Line Business Practice Location Address:
1131 N 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:
90029-1764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-923-3349
Provider Business Practice Location Address Fax Number:
323-663-0218
Provider Enumeration Date:
01/10/2009