Provider First Line Business Practice Location Address:
4314 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-293-7171
Provider Business Practice Location Address Fax Number:
310-531-2084
Provider Enumeration Date:
08/20/2006