Provider First Line Business Practice Location Address:
301 N PRAIRIE AVE
Provider Second Line Business Practice Location Address:
SUITE 411
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-4507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-621-9950
Provider Business Practice Location Address Fax Number:
310-837-7319
Provider Enumeration Date:
10/10/2008