Provider First Line Business Practice Location Address:
1145 E COMPTON BLVD
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:
90221-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-637-5555
Provider Business Practice Location Address Fax Number:
310-637-5556
Provider Enumeration Date:
09/15/2026