Provider First Line Business Practice Location Address:
1441 W 8TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-832-5295
Provider Business Practice Location Address Fax Number:
310-832-8460
Provider Enumeration Date:
10/11/2006