Provider First Line Business Practice Location Address:
301 N. PRAIRIE AVE. INGLEWOOD, CA
Provider Second Line Business Practice Location Address:
SUITE 511
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-619-5088
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2012