Provider First Line Business Practice Location Address:
11428 ARTESIA BLVD
Provider Second Line Business Practice Location Address:
SUITE # 3
Provider Business Practice Location Address City Name:
ARTESIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90701-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-860-7770
Provider Business Practice Location Address Fax Number:
562-809-1185
Provider Enumeration Date:
11/19/2005