Provider First Line Business Practice Location Address:
231 W VERNON 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:
90037-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-231-8814
Provider Business Practice Location Address Fax Number:
323-231-0134
Provider Enumeration Date:
04/28/2009