Provider First Line Business Practice Location Address:
231 W VERNON AVE STE 112
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:
90037-2778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-432-2021
Provider Business Practice Location Address Fax Number:
213-289-2133
Provider Enumeration Date:
08/28/2023