Provider First Line Business Practice Location Address:
1300 NORTH VERMONT
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-228-4399
Provider Business Practice Location Address Fax Number:
323-871-2957
Provider Enumeration Date:
12/11/2006