Provider First Line Business Practice Location Address:
1625 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:
90062-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-300-5308
Provider Business Practice Location Address Fax Number:
323-451-7158
Provider Enumeration Date:
05/05/2015