Provider First Line Business Practice Location Address:
8464 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-569-3570
Provider Business Practice Location Address Fax Number:
323-569-2046
Provider Enumeration Date:
11/08/2006