Provider First Line Business Practice Location Address:
5151 STATE UNIVERSITY DRIVE
Provider Second Line Business Practice Location Address:
CSULA - KING HALL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-435-8010
Provider Business Practice Location Address Fax Number:
323-343-2281
Provider Enumeration Date:
08/28/2008