Provider First Line Business Practice Location Address:
1061 E. VERNON AVE SUITE# F
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:
90011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-233-9686
Provider Business Practice Location Address Fax Number:
323-233-0595
Provider Enumeration Date:
04/19/2007