Provider First Line Business Practice Location Address:
2670 E GAGE AVE
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-4176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-581-9486
Provider Business Practice Location Address Fax Number:
323-581-9476
Provider Enumeration Date:
11/01/2006