Provider First Line Business Practice Location Address:
14601 PRAIRIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWNDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90260-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-676-6066
Provider Business Practice Location Address Fax Number:
310-676-6066
Provider Enumeration Date:
11/29/2006