Provider First Line Business Practice Location Address:
5211 E. WASHINGTON BLVD.
Provider Second Line Business Practice Location Address:
SECOND FLOOR
Provider Business Practice Location Address City Name:
COMMERCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-980-9002
Provider Business Practice Location Address Fax Number:
323-980-9898
Provider Enumeration Date:
07/13/2006