Provider First Line Business Practice Location Address:
5914 PACIFIC BL
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:
90255-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-581-0100
Provider Business Practice Location Address Fax Number:
323-581-2799
Provider Enumeration Date:
03/01/2007