Provider First Line Business Practice Location Address:
5938 1/2 CAMELLIA AVE.
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:
310-488-3432
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2017