Provider First Line Business Practice Location Address:
6537 MALABAR ST RM 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-4025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-923-9559
Provider Business Practice Location Address Fax Number:
323-923-9566
Provider Enumeration Date:
03/29/2018