Provider First Line Business Practice Location Address:
12225 SOUTH ST
Provider Second Line Business Practice Location Address:
#102
Provider Business Practice Location Address City Name:
ARTESIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90701-7053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-865-2402
Provider Business Practice Location Address Fax Number:
562-865-6621
Provider Enumeration Date:
10/27/2005