Provider First Line Business Practice Location Address:
4314 W SLAUSON AVE STE 4
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:
90043-2852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-300-4004
Provider Business Practice Location Address Fax Number:
323-300-6632
Provider Enumeration Date:
07/22/2026