Provider First Line Business Practice Location Address:
4149 TWEEDY BOULEVARD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-6167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-564-4545
Provider Business Practice Location Address Fax Number:
323-564-3063
Provider Enumeration Date:
05/05/2006