Provider First Line Business Practice Location Address:
945 S PRAIRIE AVE STE 201D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-5270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-952-4250
Provider Business Practice Location Address Fax Number:
310-674-0340
Provider Enumeration Date:
11/07/2009