Provider First Line Business Practice Location Address:
476 E WASHINTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EARLIMART
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-849-2781
Provider Business Practice Location Address Fax Number:
661-849-2719
Provider Enumeration Date:
06/19/2009