Provider First Line Business Practice Location Address:
3650 E. SOUTH ST.
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-602-8841
Provider Business Practice Location Address Fax Number:
562-602-8843
Provider Enumeration Date:
10/10/2006