Provider First Line Business Practice Location Address:
2930 W IMPERIAL HWY
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90303-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-777-7610
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007