Provider First Line Business Practice Location Address:
5720 E. IMPERIAL HWY
Provider Second Line Business Practice Location Address:
N-O
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:
323-776-1500
Provider Business Practice Location Address Fax Number:
855-777-2289
Provider Enumeration Date:
10/22/2024