Provider First Line Business Practice Location Address:
2521 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:
90043-3248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-293-3983
Provider Business Practice Location Address Fax Number:
323-293-3965
Provider Enumeration Date:
04/17/2009