Provider First Line Business Practice Location Address:
138 S BANDINI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-832-6031
Provider Business Practice Location Address Fax Number:
310-832-6677
Provider Enumeration Date:
09/24/2010