Provider First Line Business Practice Location Address:
4566 E. FLORENCE AVE. SUITE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-538-7003
Provider Business Practice Location Address Fax Number:
323-538-7423
Provider Enumeration Date:
09/14/2015