Provider First Line Business Practice Location Address:
534 W VERNON 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:
90037-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-801-5786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2026