Provider First Line Business Practice Location Address:
4566 FLORENCE AVE STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-582-5458
Provider Business Practice Location Address Fax Number:
323-835-1475
Provider Enumeration Date:
12/15/2006