Provider First Line Business Practice Location Address:
1250 E 223RD ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-522-4120
Provider Business Practice Location Address Fax Number:
310-522-4558
Provider Enumeration Date:
03/22/2010