Provider First Line Business Practice Location Address:
6319 MARBRISA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-688-2924
Provider Business Practice Location Address Fax Number:
213-688-2925
Provider Enumeration Date:
06/30/2014