Provider First Line Business Practice Location Address:
1212 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:
90029-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-443-3225
Provider Business Practice Location Address Fax Number:
323-927-0105
Provider Enumeration Date:
11/17/2020