Provider First Line Business Practice Location Address:
5608 S SOTO ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-393-7347
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007