Provider First Line Business Practice Location Address:
323 N. PRAIRIE
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-672-2008
Provider Business Practice Location Address Fax Number:
310-672-2166
Provider Enumeration Date:
01/25/2007