Provider First Line Business Practice Location Address:
4311 W 147TH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWNDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90260-1573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-675-5939
Provider Business Practice Location Address Fax Number:
877-546-5929
Provider Enumeration Date:
02/28/2008