Provider First Line Business Practice Location Address:
3535 W IMPERIAL HWY STE B
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:
90303-6204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-622-0384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006