Provider First Line Business Practice Location Address:
5201 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:
90037-3527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-751-2677
Provider Business Practice Location Address Fax Number:
323-752-8547
Provider Enumeration Date:
01/23/2007