Provider First Line Business Practice Location Address:
1360 W. SIXTH STREET
Provider Second Line Business Practice Location Address:
STE. 200
Provider Business Practice Location Address City Name:
SAN PEDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90732-3514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-547-9922
Provider Business Practice Location Address Fax Number:
310-547-4673
Provider Enumeration Date:
08/05/2006