Provider First Line Business Practice Location Address:
5405 BALDWIN AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91780-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-282-4548
Provider Business Practice Location Address Fax Number:
626-872-2571
Provider Enumeration Date:
09/22/2006