Provider First Line Business Practice Location Address:
13175 PARAMOUNT BLVD
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:
90280-7955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-633-9137
Provider Business Practice Location Address Fax Number:
562-633-9185
Provider Enumeration Date:
04/19/2007