Provider First Line Business Practice Location Address:
145 N PRAIRE 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:
90301-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-529-3269
Provider Business Practice Location Address Fax Number:
323-545-3156
Provider Enumeration Date:
01/03/2019