Provider First Line Business Practice Location Address:
2709 KANSAS 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:
90280-4023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-513-6186
Provider Business Practice Location Address Fax Number:
323-563-3434
Provider Enumeration Date:
02/17/2009