Provider First Line Business Practice Location Address:
3036 LIVE OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-6106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-236-8327
Provider Business Practice Location Address Fax Number:
855-250-1528
Provider Enumeration Date:
09/24/2020