Provider First Line Business Practice Location Address:
11428 E. ARTESIA BLVD STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARTESIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90701-3872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-865-4191
Provider Business Practice Location Address Fax Number:
562-865-4192
Provider Enumeration Date:
03/29/2012