Provider First Line Business Practice Location Address:
3211 WEST IMPERIAL HWY
Provider Second Line Business Practice Location Address:
SAME AS MAILING ADDRESS
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-419-9616
Provider Business Practice Location Address Fax Number:
310-419-9617
Provider Enumeration Date:
07/02/2007