Provider First Line Business Practice Location Address:
231 W VERNON AVE.
Provider Second Line Business Practice Location Address:
STE. 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:
90037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-232-1111
Provider Business Practice Location Address Fax Number:
323-232-1113
Provider Enumeration Date:
02/14/2007