Provider First Line Business Practice Location Address:
3612 E 60TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-379-1833
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/21/2025