Provider First Line Business Practice Location Address:
10418 S PRAIRIE AVE STE A
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:
90303-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-673-7100
Provider Business Practice Location Address Fax Number:
310-673-7101
Provider Enumeration Date:
10/10/2008