Provider First Line Business Practice Location Address:
301 N PRAIRIE AVE
Provider Second Line Business Practice Location Address:
120
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:
310-677-6101
Provider Business Practice Location Address Fax Number:
310-677-9327
Provider Enumeration Date:
08/18/2006