Provider First Line Business Practice Location Address:
6208 SEVILLE AVE
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:
90255-2913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-589-5880
Provider Business Practice Location Address Fax Number:
323-589-5886
Provider Enumeration Date:
10/30/2012