Provider First Line Business Practice Location Address:
323 N. PRAIRIE AVE
Provider Second Line Business Practice Location Address:
SUITE 460
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:
310-674-9010
Provider Business Practice Location Address Fax Number:
310-677-5072
Provider Enumeration Date:
01/26/2007