Provider First Line Business Practice Location Address:
1945 W 147TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90249-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-327-1469
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2014