Provider First Line Business Practice Location Address:
5942 RUGBY AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-585-7605
Provider Business Practice Location Address Fax Number:
323-585-7635
Provider Enumeration Date:
04/10/2009