Provider First Line Business Practice Location Address:
1091 S LA BREA AVE
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:
90301-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-330-2960
Provider Business Practice Location Address Fax Number:
310-330-2961
Provider Enumeration Date:
02/07/2007