Provider First Line Business Practice Location Address:
1001 S. SEASIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-521-6065
Provider Business Practice Location Address Fax Number:
310-521-6079
Provider Enumeration Date:
12/13/2006