Provider First Line Business Practice Location Address:
1508 W 253RD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-464-2929
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2025