Provider First Line Business Practice Location Address:
2918 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:
90008-4757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-497-8150
Provider Business Practice Location Address Fax Number:
323-292-5543
Provider Enumeration Date:
05/07/2007