Provider First Line Business Practice Location Address:
8407 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:
90044-3423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-971-1325
Provider Business Practice Location Address Fax Number:
323-971-1365
Provider Enumeration Date:
02/20/2007