Provider First Line Business Practice Location Address:
330 FERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731-7415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-947-6271
Provider Business Practice Location Address Fax Number:
213-351-2490
Provider Enumeration Date:
07/26/2023