Provider First Line Business Practice Location Address:
323 N PRAIRIE AVE # 334
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:
90301-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-674-8600
Provider Business Practice Location Address Fax Number:
310-671-9883
Provider Enumeration Date:
07/30/2006