Provider First Line Business Practice Location Address:
1300 W 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 1
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-831-1266
Provider Business Practice Location Address Fax Number:
424-342-7888
Provider Enumeration Date:
03/23/2007