Provider First Line Business Practice Location Address:
1727 N VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE #109
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-4343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-644-3366
Provider Business Practice Location Address Fax Number:
323-644-0838
Provider Enumeration Date:
06/21/2006