Provider First Line Business Practice Location Address:
105 1/2 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:
90004-5904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-383-8036
Provider Business Practice Location Address Fax Number:
213-385-1196
Provider Enumeration Date:
11/02/2006