Provider First Line Business Practice Location Address:
3650 E. SOUTH ST.
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-923-4911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2005