Provider First Line Business Practice Location Address:
409 S 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:
90301-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-545-3709
Provider Business Practice Location Address Fax Number:
818-827-3350
Provider Enumeration Date:
05/24/2007