Provider First Line Business Practice Location Address:
1300 NORTH VERMONT HOLLYWOOD
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:
90027-9002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-522-6857
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2022