Provider First Line Business Practice Location Address:
2020 S 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:
90220-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-219-1779
Provider Business Practice Location Address Fax Number:
310-946-0345
Provider Enumeration Date:
02/14/2007