Provider First Line Business Practice Location Address:
16249 PARAMOUNT BLVD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-5463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-272-8500
Provider Business Practice Location Address Fax Number:
562-272-0014
Provider Enumeration Date:
08/31/2006