Provider First Line Business Practice Location Address:
4914 1/2 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:
90056-1639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-348-4205
Provider Business Practice Location Address Fax Number:
323-348-4213
Provider Enumeration Date:
01/08/2025