Provider First Line Business Practice Location Address:
5600 PACIFIC BLVD
Provider Second Line Business Practice Location Address:
SUITE#A
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-2537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-585-2100
Provider Business Practice Location Address Fax Number:
323-585-6545
Provider Enumeration Date:
08/31/2006