Provider First Line Business Practice Location Address:
1580 W ROSECRANS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90220-1001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-631-3085
Provider Business Practice Location Address Fax Number:
310-631-3670
Provider Enumeration Date:
02/02/2009