Provider First Line Business Practice Location Address:
12137 E CARSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAWAIIAN GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-402-8060
Provider Business Practice Location Address Fax Number:
562-809-1552
Provider Enumeration Date:
12/20/2006