Provider First Line Business Practice Location Address:
1312A S TEMPLE AVE
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:
90221-5022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-794-3962
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2017