Provider First Line Business Practice Location Address:
1228 E COMPTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90221-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-608-1505
Provider Business Practice Location Address Fax Number:
310-608-1406
Provider Enumeration Date:
02/09/2011