Provider First Line Business Practice Location Address:
8524 1/2 ROSECRANS AVE
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:
90723-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-633-3082
Provider Business Practice Location Address Fax Number:
562-633-3067
Provider Enumeration Date:
05/17/2013