Provider First Line Business Practice Location Address:
3209 N ALAMEDA ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90222-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-638-1102
Provider Business Practice Location Address Fax Number:
888-552-5793
Provider Enumeration Date:
05/05/2010