Provider First Line Business Practice Location Address:
1645 ANAHEIM ST.
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:
90710-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-344-0541
Provider Business Practice Location Address Fax Number:
888-444-9401
Provider Enumeration Date:
09/10/2012