Provider First Line Business Practice Location Address:
12146 SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
ARTESIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90701-6844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-924-1007
Provider Business Practice Location Address Fax Number:
562-924-1267
Provider Enumeration Date:
07/22/2015