Provider First Line Business Practice Location Address:
8453 S VAN NESS 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:
90305-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-778-1177
Provider Business Practice Location Address Fax Number:
323-778-2477
Provider Enumeration Date:
04/30/2008