Provider First Line Business Practice Location Address:
4004 S VERMONT AVE
Provider Second Line Business Practice Location Address:
#1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-7098
Provider Business Practice Location Address Fax Number:
323-233-1173
Provider Enumeration Date:
08/23/2006