Provider First Line Business Practice Location Address:
10202 GREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91780-3336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-455-0677
Provider Business Practice Location Address Fax Number:
626-401-3259
Provider Enumeration Date:
02/02/2007