Provider First Line Business Practice Location Address:
1321 N VERMONT AVE
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-663-7897
Provider Business Practice Location Address Fax Number:
323-663-7803
Provider Enumeration Date:
07/11/2005