Provider First Line Business Practice Location Address:
501 E HARDY ST STE 220
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:
90301-4054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-290-2832
Provider Business Practice Location Address Fax Number:
323-290-2836
Provider Enumeration Date:
07/13/2005