Provider First Line Business Practice Location Address:
3300 E SOUTH ST
Provider Second Line Business Practice Location Address:
SUITE #: 102
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90805-4549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-232-1144
Provider Business Practice Location Address Fax Number:
562-630-3052
Provider Enumeration Date:
12/20/2011