Provider First Line Business Practice Location Address:
1058 S VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90006-2721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-368-6020
Provider Business Practice Location Address Fax Number:
213-927-0504
Provider Enumeration Date:
09/17/2008