Provider First Line Business Practice Location Address:
24328 VERMONT AVE
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-539-5525
Provider Business Practice Location Address Fax Number:
310-539-5529
Provider Enumeration Date:
07/06/2006