Provider First Line Business Practice Location Address:
1621 S ALAMEDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90220-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-631-3735
Provider Business Practice Location Address Fax Number:
310-638-1326
Provider Enumeration Date:
02/16/2007