Provider First Line Business Practice Location Address:
3703 TWEEDY BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-566-1146
Provider Business Practice Location Address Fax Number:
323-581-2106
Provider Enumeration Date:
12/22/2010