Provider First Line Business Practice Location Address:
1037 W VERNON 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:
90037-2415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-232-4895
Provider Business Practice Location Address Fax Number:
323-232-3096
Provider Enumeration Date:
02/07/2008