Provider First Line Business Practice Location Address:
5863 EAST IMPERIAL HWY
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-7626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-861-6232
Provider Business Practice Location Address Fax Number:
562-861-9291
Provider Enumeration Date:
06/28/2006