Provider First Line Business Practice Location Address:
7119 RITA AVE
Provider Second Line Business Practice Location Address:
SUITE C, E, F
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-4781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-582-4980
Provider Business Practice Location Address Fax Number:
323-582-4914
Provider Enumeration Date:
04/25/2007