Provider First Line Business Practice Location Address:
15027 SOUTH PRAIRIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWNDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-970-9040
Provider Business Practice Location Address Fax Number:
310-970-9201
Provider Enumeration Date:
07/28/2006