Provider First Line Business Practice Location Address:
3118 E FLORENCE AVE
Provider Second Line Business Practice Location Address:
STE #2
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-5830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-587-1616
Provider Business Practice Location Address Fax Number:
323-587-1767
Provider Enumeration Date:
08/04/2006