Provider First Line Business Practice Location Address:
16815 PRAIRIE AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWNDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90260-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
424-215-2105
Provider Business Practice Location Address Fax Number:
424-675-4064
Provider Enumeration Date:
02/23/2022