Provider First Line Business Practice Location Address:
2623 E SLAUSON AVE
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:
90255-2926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-585-2486
Provider Business Practice Location Address Fax Number:
323-585-7455
Provider Enumeration Date:
06/03/2006