Provider First Line Business Practice Location Address:
7910 ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMOUNT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90723-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-630-2569
Provider Business Practice Location Address Fax Number:
562-630-2522
Provider Enumeration Date:
02/13/2007