Provider First Line Business Practice Location Address:
9918 ATLANTIC AVENEUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-567-1227
Provider Business Practice Location Address Fax Number:
323-567-2181
Provider Enumeration Date:
10/30/2015