Provider First Line Business Practice Location Address:
1300 W. 6TH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-831-8449
Provider Business Practice Location Address Fax Number:
310-831-0963
Provider Enumeration Date:
10/04/2012