Provider First Line Business Practice Location Address:
3730 E SOUTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-899-4005
Provider Business Practice Location Address Fax Number:
714-899-4275
Provider Enumeration Date:
11/02/2005