Provider First Line Business Practice Location Address:
9739 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-566-2222
Provider Business Practice Location Address Fax Number:
323-567-2222
Provider Enumeration Date:
11/22/2009