Provider First Line Business Practice Location Address:
2619 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:
90043-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-296-1449
Provider Business Practice Location Address Fax Number:
323-296-4525
Provider Enumeration Date:
02/27/2008