Provider First Line Business Practice Location Address:
4400 BRIERCREST AVE
Provider Second Line Business Practice Location Address:
LAKEWOOD HS LBUSD
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90713-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-425-1282
Provider Business Practice Location Address Fax Number:
562-425-0543
Provider Enumeration Date:
04/24/2007