Provider First Line Business Practice Location Address:
356 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:
90020-1807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-386-1418
Provider Business Practice Location Address Fax Number:
213-386-1417
Provider Enumeration Date:
07/16/2014