Provider First Line Business Practice Location Address:
14148 FRANCISQUITO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALDWIN PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91706-6120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-626-7816
Provider Business Practice Location Address Fax Number:
213-621-7787
Provider Enumeration Date:
10/26/2005