Provider First Line Business Practice Location Address:
201 N CENTRAL AVE
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:
90220-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-635-7123
Provider Business Practice Location Address Fax Number:
310-635-0535
Provider Enumeration Date:
04/13/2011