Provider First Line Business Practice Location Address:
753 S 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:
90005-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-385-2875
Provider Business Practice Location Address Fax Number:
213-385-2870
Provider Enumeration Date:
08/25/2010