Provider First Line Business Practice Location Address:
VAGLAHS- EAST LA PCT SUITE 150
Provider Second Line Business Practice Location Address:
5400 E OLYMPIC BLVD
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90022-5147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-725-7557
Provider Business Practice Location Address Fax Number:
323-725-7577
Provider Enumeration Date:
07/15/2006