Provider First Line Business Practice Location Address:
2530 1/2 SANTA ANA 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:
90255-6629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-471-1283
Provider Business Practice Location Address Fax Number:
512-900-6260
Provider Enumeration Date:
06/11/2026