Provider First Line Business Practice Location Address:
1191 N VERMONT AVE
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90029-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-668-1535
Provider Business Practice Location Address Fax Number:
323-668-0666
Provider Enumeration Date:
08/01/2006