Provider First Line Business Practice Location Address:
819 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:
90005-1522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-300-5266
Provider Business Practice Location Address Fax Number:
213-568-3077
Provider Enumeration Date:
10/23/2019