Provider First Line Business Practice Location Address:
3400 E FLORENCE AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-5835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-5157
Provider Business Practice Location Address Fax Number:
323-588-6878
Provider Enumeration Date:
12/13/2005