Provider First Line Business Practice Location Address:
1036 W STOCKWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90222-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-352-6038
Provider Business Practice Location Address Fax Number:
323-967-7300
Provider Enumeration Date:
08/31/2023