Provider First Line Business Practice Location Address:
3591 EAST IMPERIAL HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LYNWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-631-2838
Provider Business Practice Location Address Fax Number:
310-632-4701
Provider Enumeration Date:
10/19/2006