Provider First Line Business Practice Location Address:
1931 N GAFFEY ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731-1265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-253-5055
Provider Business Practice Location Address Fax Number:
714-680-3463
Provider Enumeration Date:
12/12/2006