Provider First Line Business Practice Location Address:
2613 SATURN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-588-7371
Provider Business Practice Location Address Fax Number:
323-588-1427
Provider Enumeration Date:
03/27/2007