Provider First Line Business Practice Location Address:
916 N MARKET ST
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:
90302-2345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-419-4206
Provider Business Practice Location Address Fax Number:
310-419-8011
Provider Enumeration Date:
01/13/2006