Provider First Line Business Practice Location Address:
1300 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:
90027-6098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
134-133-0002
Provider Business Practice Location Address Fax Number:
323-666-2939
Provider Enumeration Date:
08/14/2006