Provider First Line Business Practice Location Address: 
500 N GARFIELD AVE STE 204
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
MONTEREY PARK
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
91754-1242
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
626-280-4393
    Provider Business Practice Location Address Fax Number: 
626-280-5379
    Provider Enumeration Date: 
04/15/2020