Provider First Line Business Practice Location Address:
1533 N VERMONT AVE
Provider Second Line Business Practice Location Address:
RITE AID PHARMACY #5435
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-5330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-597-3658
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2010