Provider First Line Business Practice Location Address:
12144 E CARSON ST
Provider Second Line Business Practice Location Address:
# E
Provider Business Practice Location Address City Name:
HAWAIIAN GARDENS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-982-1380
Provider Business Practice Location Address Fax Number:
562-982-1383
Provider Enumeration Date:
05/03/2007