Provider First Line Business Practice Location Address:
555 E HARDY STREET
Provider Second Line Business Practice Location Address:
INGLEWOOD CA 90301
Provider Business Practice Location Address City Name:
LOS ANGELES
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:
310-680-1913
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2026