Provider First Line Business Practice Location Address:
7922 ROSECRANS AVE.
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-6043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-633-7172
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2009