Provider First Line Business Practice Location Address:
132 S VERMONT AVE STE 204
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:
90004-5955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-389-2526
Provider Business Practice Location Address Fax Number:
213-389-2506
Provider Enumeration Date:
11/17/2006