Provider First Line Business Practice Location Address:
16427 S HARRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90221-5217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-336-6946
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2026