Provider First Line Business Practice Location Address:
1350 W 6TH ST
Provider Second Line Business Practice Location Address:
SECOND FLOOR, SUITE 7
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-802-3219
Provider Business Practice Location Address Fax Number:
310-831-3000
Provider Enumeration Date:
05/25/2006