Provider First Line Business Practice Location Address:
1900 SO ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-728-6777
Provider Business Practice Location Address Fax Number:
323-728-6778
Provider Enumeration Date:
09/04/2008