Provider First Line Business Practice Location Address:
9844 ATLANTIC AVE
Provider Second Line Business Practice Location Address:
SUITE #A
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-5219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-631-3502
Provider Business Practice Location Address Fax Number:
310-631-5143
Provider Enumeration Date:
07/12/2006