Provider First Line Business Practice Location Address:
501 EAST HARDY STREET
Provider Second Line Business Practice Location Address:
SUITE 407
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:
310-673-7724
Provider Business Practice Location Address Fax Number:
310-673-5895
Provider Enumeration Date:
11/08/2006