Provider First Line Business Practice Location Address:
1601 237TH ST UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARBOR CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90710-1324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-218-8106
Provider Business Practice Location Address Fax Number:
310-325-6138
Provider Enumeration Date:
08/18/2008