Provider First Line Business Practice Location Address:
132 S VERMONT AVENUE
Provider Second Line Business Practice Location Address:
SUITE #210
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-389-2625
Provider Business Practice Location Address Fax Number:
213-389-4736
Provider Enumeration Date:
06/19/2007