Provider First Line Business Practice Location Address:
7507 5 SEVILLE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-1231
Provider Business Practice Location Address Fax Number:
323-588-1232
Provider Enumeration Date:
02/05/2007