Provider First Line Business Practice Location Address:
8847 IMPERIAL HWY
Provider Second Line Business Practice Location Address:
C-1
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90242-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-861-1177
Provider Business Practice Location Address Fax Number:
562-861-1199
Provider Enumeration Date:
01/16/2009