Provider First Line Business Practice Location Address:
722 N 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:
90302-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-673-9910
Provider Business Practice Location Address Fax Number:
310-673-9914
Provider Enumeration Date:
02/26/2007