Provider First Line Business Practice Location Address:
1609 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:
90027-5312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-663-8346
Provider Business Practice Location Address Fax Number:
323-663-2316
Provider Enumeration Date:
04/13/2023