Provider First Line Business Practice Location Address:
6814 1/2 FRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELL GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-6399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-395-8512
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2021