Provider First Line Business Practice Location Address:
6021 CARMELITA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-3320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-694-0045
Provider Business Practice Location Address Fax Number:
323-773-5201
Provider Enumeration Date:
03/29/2007