Provider First Line Business Practice Location Address:
4225 TWEEDY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-6217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-564-6464
Provider Business Practice Location Address Fax Number:
323-564-8578
Provider Enumeration Date:
06/01/2007