Provider First Line Business Practice Location Address:
1214 1/2 S GREENWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-6329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-728-3272
Provider Business Practice Location Address Fax Number:
323-728-3292
Provider Enumeration Date:
11/22/2006