Provider First Line Business Practice Location Address:
5580 IMPERIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-7418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-869-0106
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2009