Provider First Line Business Practice Location Address:
607 E 228TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARSON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-522-0125
Provider Business Practice Location Address Fax Number:
310-518-5005
Provider Enumeration Date:
02/27/2007