Provider First Line Business Practice Location Address:
1946 E ROSECRANS AVE
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:
90221-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-868-9560
Provider Business Practice Location Address Fax Number:
310-868-9221
Provider Enumeration Date:
12/11/2006