Provider First Line Business Practice Location Address:
CAL STATE DOMINGUEZ HLS
Provider Second Line Business Practice Location Address:
1000 E. VICTORIA ST.
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90747-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-243-3894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2006