Provider First Line Business Practice Location Address:
159 S VERMONT AVE
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:
90004-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-388-2044
Provider Business Practice Location Address Fax Number:
213-632-0140
Provider Enumeration Date:
08/04/2006