Provider First Line Business Practice Location Address:
1135 S MEYLER ST
Provider Second Line Business Practice Location Address:
1127 SO. MEYLER AVENUE
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90731-3534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-548-3471
Provider Business Practice Location Address Fax Number:
310-519-1673
Provider Enumeration Date:
09/27/2006