Provider First Line Business Practice Location Address:
1410 W. ALONDRA BLVD.
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90220-3533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-637-3680
Provider Business Practice Location Address Fax Number:
310-637-3679
Provider Enumeration Date:
08/02/2005