Provider First Line Business Practice Location Address:
8300 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:
90044-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-965-6165
Provider Business Practice Location Address Fax Number:
323-789-3363
Provider Enumeration Date:
09/11/2007