Provider First Line Business Practice Location Address:
11747 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARTESIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90701-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-865-3635
Provider Business Practice Location Address Fax Number:
562-865-1866
Provider Enumeration Date:
04/22/2009