Provider First Line Business Practice Location Address:
111 NO. LA BREA
Provider Second Line Business Practice Location Address:
SUITE 611
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:
310-412-1523
Provider Business Practice Location Address Fax Number:
310-330-4723
Provider Enumeration Date:
01/12/2007