Provider First Line Business Practice Location Address:
4221 S ALAMEDA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90058-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-676-5111
Provider Business Practice Location Address Fax Number:
323-676-5112
Provider Enumeration Date:
05/17/2017