Provider First Line Business Practice Location Address:
7635 1/2 PACIFIC BLVD
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:
90255-6043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-0742
Provider Business Practice Location Address Fax Number:
323-588-6805
Provider Enumeration Date:
09/25/2006