Provider First Line Business Practice Location Address:
5151 STATE UNIVERSITY DR
Provider Second Line Business Practice Location Address:
CALIFORNIA STATE UNIVERSITY LOS ANGELES
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90032-4226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-343-4738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2005