Provider First Line Business Practice Location Address:
1321 NO. VERMONT AVE. STE 1-A
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:
90027-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-663-8842
Provider Business Practice Location Address Fax Number:
323-663-8843
Provider Enumeration Date:
04/29/2014