Provider First Line Business Practice Location Address:
326 N VERMONT AVE STE B
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:
90004-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-668-1766
Provider Business Practice Location Address Fax Number:
323-668-1348
Provider Enumeration Date:
08/23/2016