Provider First Line Business Practice Location Address:
1200 N VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90029-1760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-665-5749
Provider Business Practice Location Address Fax Number:
323-665-5740
Provider Enumeration Date:
05/25/2006