Provider First Line Business Practice Location Address:
1300 N VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-6005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-880-1277
Provider Business Practice Location Address Fax Number:
909-980-7779
Provider Enumeration Date:
03/28/2007