Provider First Line Business Practice Location Address:
968 W VERNON AV
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-234-4889
Provider Business Practice Location Address Fax Number:
323-231-1448
Provider Enumeration Date:
10/04/2006