Provider First Line Business Practice Location Address: 
8835 E LAS TUNAS DR
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
TEMPLE CITY
    Provider Business Practice Location Address State Name: 
CA
    Provider Business Practice Location Address Postal Code: 
91780
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
626-285-7588
    Provider Business Practice Location Address Fax Number: 
626-285-7589
    Provider Enumeration Date: 
01/04/2008