Provider First Line Business Practice Location Address:
10132 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-566-4411
Provider Business Practice Location Address Fax Number:
323-566-0390
Provider Enumeration Date:
01/09/2008