Provider First Line Business Practice Location Address:
1411 W 7TH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-831-5550
Provider Business Practice Location Address Fax Number:
310-669-3094
Provider Enumeration Date:
06/16/2011