Provider First Line Business Practice Location Address:
2521 E FLORENCE AVE
Provider Second Line Business Practice Location Address:
SUITE B-2
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-4755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-582-4600
Provider Business Practice Location Address Fax Number:
323-582-4611
Provider Enumeration Date:
02/29/2008