Provider First Line Business Practice Location Address:
605 W. 6TH STREET
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:
310-241-0330
Provider Business Practice Location Address Fax Number:
310-241-0719
Provider Enumeration Date:
01/25/2007