Provider First Line Business Practice Location Address:
1613 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:
90006-4521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-731-8000
Provider Business Practice Location Address Fax Number:
323-731-8005
Provider Enumeration Date:
09/12/2016