Provider First Line Business Practice Location Address:
1680 TARTAR LANE
Provider Second Line Business Practice Location Address:
22
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-805-1113
Provider Business Practice Location Address Fax Number:
310-884-9375
Provider Enumeration Date:
10/15/2010