Provider First Line Business Practice Location Address:
4155 TWEEDY BLVD
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:
323-569-0744
Provider Business Practice Location Address Fax Number:
323-569-3469
Provider Enumeration Date:
05/25/2006