Provider First Line Business Practice Location Address:
301 N. PRAIRIE AVE
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-603-2345
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007