Provider First Line Business Practice Location Address:
1407 N VERMONT AVE STE B
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:
90027-6023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-486-7021
Provider Business Practice Location Address Fax Number:
323-967-2821
Provider Enumeration Date:
07/28/2021