Provider First Line Business Practice Location Address:
1514 S VERMONT AVE STE I-2
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:
90006-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-381-6087
Provider Business Practice Location Address Fax Number:
213-381-6085
Provider Enumeration Date:
10/11/2007