Provider First Line Business Practice Location Address:
10010 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-6006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-567-2425
Provider Business Practice Location Address Fax Number:
323-567-2427
Provider Enumeration Date:
05/30/2006