Provider First Line Business Practice Location Address:
1407 N VERMONT AVE
Provider Second Line Business Practice Location Address:
A
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-6023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-913-3377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2005