Provider First Line Business Practice Location Address:
2639 WALNUT ST
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:
90255-5709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-581-3226
Provider Business Practice Location Address Fax Number:
323-585-0203
Provider Enumeration Date:
02/08/2007