Provider First Line Business Practice Location Address:
222 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731-3316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-595-8894
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2022