Provider First Line Business Practice Location Address:
1300 NORTH VERMONT AVENUE
Provider Second Line Business Practice Location Address:
DOCTOR'S TOWER, SUITE 100
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-484-4350
Provider Business Practice Location Address Fax Number:
323-913-4351
Provider Enumeration Date:
09/25/2006