Provider First Line Business Practice Location Address:
4000 W SLAUSON 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:
90043-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-722-2742
Provider Business Practice Location Address Fax Number:
310-876-0686
Provider Enumeration Date:
05/06/2009