Provider First Line Business Practice Location Address:
5029 S VERMONT AVE
Provider Second Line Business Practice Location Address:
TEEN CENTER
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90037-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-327-8677
Provider Business Practice Location Address Fax Number:
323-735-5387
Provider Enumeration Date:
06/04/2013