Provider First Line Business Practice Location Address:
1300 W. 7TH STREET
Provider Second Line Business Practice Location Address:
BRIDGES UNIT, 4 EAST
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-832-3311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/01/2020