Provider First Line Business Practice Location Address:
501 E HARDY ST
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-4054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-671-6364
Provider Business Practice Location Address Fax Number:
310-671-8184
Provider Enumeration Date:
07/25/2008