Provider First Line Business Practice Location Address:
11502 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:
90044-6522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-755-2742
Provider Business Practice Location Address Fax Number:
323-755-8787
Provider Enumeration Date:
03/27/2007