Provider First Line Business Practice Location Address:
954 N 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:
90029-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-666-6866
Provider Business Practice Location Address Fax Number:
323-666-9996
Provider Enumeration Date:
04/27/2007