Provider First Line Business Practice Location Address:
575 E HARDY ST STE 212
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:
90301-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-742-2245
Provider Business Practice Location Address Fax Number:
310-742-2275
Provider Enumeration Date:
01/09/2007