Provider First Line Business Practice Location Address:
226 BARRANCA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-321-2273
Provider Business Practice Location Address Fax Number:
213-321-2273
Provider Enumeration Date:
10/21/2025