Provider First Line Business Practice Location Address:
3922 CANDLEWOOD ST
Provider Second Line Business Practice Location Address:
3922 3/4
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-987-8744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2026