Provider First Line Business Practice Location Address:
7500 ROSECRANS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-2506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-634-9142
Provider Business Practice Location Address Fax Number:
562-634-5896
Provider Enumeration Date:
03/15/2007