Provider First Line Business Practice Location Address:
3512 E FLORENCE AVE.
Provider Second Line Business Practice Location Address:
SUITE 102 & 103
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-582-1180
Provider Business Practice Location Address Fax Number:
323-582-8280
Provider Enumeration Date:
09/29/2022