Provider First Line Business Practice Location Address:
6325 PACIFIC BLVD
Provider Second Line Business Practice Location Address:
STE. 104
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-4100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-581-4466
Provider Business Practice Location Address Fax Number:
323-587-8650
Provider Enumeration Date:
12/28/2005