Provider First Line Business Practice Location Address:
3019 WEST SLAUSON AVENUE
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:
323-292-6267
Provider Business Practice Location Address Fax Number:
323-292-9216
Provider Enumeration Date:
03/19/2008