Provider First Line Business Practice Location Address:
2430 IOWA AVE
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-972-3928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007