Provider First Line Business Practice Location Address:
978 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:
90006-1611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-736-0205
Provider Business Practice Location Address Fax Number:
213-368-0504
Provider Enumeration Date:
08/22/2007