Provider First Line Business Practice Location Address:
1306 W SEPULVEDA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-891-2277
Provider Business Practice Location Address Fax Number:
310-891-3877
Provider Enumeration Date:
11/24/2006