Provider First Line Business Practice Location Address: 
3221 TORRANCE BLVD
    Provider Second Line Business Practice Location Address: 
HARBOR AREA OFFICE
    Provider Business Practice Location Address City Name: 
TORRANCE
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
90503
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
310-222-2672
    Provider Business Practice Location Address Fax Number: 
310-212-0725
    Provider Enumeration Date: 
12/06/2007