Provider First Line Business Practice Location Address:
3480 LIVE OAK ST.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-582-5159
Provider Business Practice Location Address Fax Number:
323-582-1815
Provider Enumeration Date:
07/24/2013