Provider First Line Business Practice Location Address:
24328 S. VERMONT AVE.
Provider Second Line Business Practice Location Address:
STE. 212
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-530-9097
Provider Business Practice Location Address Fax Number:
310-530-9097
Provider Enumeration Date:
02/22/2012