Provider First Line Business Practice Location Address:
9739 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-567-1212
Provider Business Practice Location Address Fax Number:
323-564-6161
Provider Enumeration Date:
07/05/2007