Provider First Line Business Practice Location Address:
3100 E FLORENCE AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-5848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-3125
Provider Business Practice Location Address Fax Number:
323-588-0919
Provider Enumeration Date:
12/08/2010