Provider First Line Business Practice Location Address:
601 N. VERMONT AVE.
Provider Second Line Business Practice Location Address:
105
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-522-3842
Provider Business Practice Location Address Fax Number:
323-522-3844
Provider Enumeration Date:
08/29/2012