Provider First Line Business Practice Location Address:
3637 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-537-9230
Provider Business Practice Location Address Fax Number:
310-537-9022
Provider Enumeration Date:
02/12/2008