Provider First Line Business Practice Location Address:
8116 CALIFORNIA AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SOUTH GATE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90280-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-567-1821
Provider Business Practice Location Address Fax Number:
323-567-1821
Provider Enumeration Date:
01/24/2013