Provider First Line Business Practice Location Address:
13623 DEMPSTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90242-5118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-445-1332
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2025