Provider First Line Business Practice Location Address:
4747 LIVE OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-5113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-572-7023
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2024