Provider First Line Business Practice Location Address:
906 N. 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:
90029-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-522-3382
Provider Business Practice Location Address Fax Number:
323-934-4787
Provider Enumeration Date:
12/29/2011