Provider First Line Business Practice Location Address:
4566 E. FLORENCE AVE
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-4347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-562-1577
Provider Business Practice Location Address Fax Number:
323-773-5140
Provider Enumeration Date:
05/26/2009