Provider First Line Business Practice Location Address:
162 E COMPTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90220-2411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-603-1275
Provider Business Practice Location Address Fax Number:
310-603-1298
Provider Enumeration Date:
05/14/2007