Provider First Line Business Practice Location Address:
546 W COMPTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90220-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-885-2117
Provider Business Practice Location Address Fax Number:
310-537-9653
Provider Enumeration Date:
11/13/2006