Provider First Line Business Practice Location Address:
1403 WEST LOMITA BLVD., 2ND FLOOR, CLINIC B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710-2076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-738-3111
Provider Business Practice Location Address Fax Number:
213-386-5282
Provider Enumeration Date:
05/12/2014