Provider First Line Business Practice Location Address:
3700 E. SOUTH ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-580-6120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2016