Provider First Line Business Practice Location Address:
7922 ROSECRANS AVE
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-6009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-633-7172
Provider Business Practice Location Address Fax Number:
562-633-1610
Provider Enumeration Date:
10/30/2008