Provider First Line Business Practice Location Address:
4501 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:
90043-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-292-4114
Provider Business Practice Location Address Fax Number:
323-292-4478
Provider Enumeration Date:
05/13/2016