Provider First Line Business Practice Location Address:
4566 FLORENCE AVE
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-4347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-773-3332
Provider Business Practice Location Address Fax Number:
323-773-2102
Provider Enumeration Date:
06/20/2006