Provider First Line Business Practice Location Address:
3851 S SOTO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90058-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-585-7162
Provider Business Practice Location Address Fax Number:
323-585-0167
Provider Enumeration Date:
08/31/2006