Provider First Line Business Practice Location Address:
25481 DODGE AVE.
Provider Second Line Business Practice Location Address:
BLDG. #3
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710-3140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-556-1453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2007