Provider First Line Business Practice Location Address:
3209 N ALAMEDA ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90222-1455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-537-2273
Provider Business Practice Location Address Fax Number:
310-537-2139
Provider Enumeration Date:
10/09/2007