Provider First Line Business Practice Location Address:
3221 N ALAMEDA ST
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90222-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-604-7751
Provider Business Practice Location Address Fax Number:
310-537-9753
Provider Enumeration Date:
03/26/2007