Provider First Line Business Practice Location Address:
3122 E FLORENCE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-5830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-0001
Provider Business Practice Location Address Fax Number:
999-999-9999
Provider Enumeration Date:
10/01/2014