Provider First Line Business Practice Location Address:
2958 E FLORENCE AVE FL 2 ROOMS 8,9,10,11
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:
90255-5826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-923-9559
Provider Business Practice Location Address Fax Number:
323-923-9566
Provider Enumeration Date:
07/27/2010