Provider First Line Business Practice Location Address:
11401 BLOOMFIELD AVE
Provider Second Line Business Practice Location Address:
METROPOLITAN STATE HOSPITAL
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90650-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-651-5475
Provider Business Practice Location Address Fax Number:
951-736-9449
Provider Enumeration Date:
08/05/2006