Provider First Line Business Practice Location Address:
660 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-488-4711
Provider Business Practice Location Address Fax Number:
818-337-7105
Provider Enumeration Date:
03/19/2007