Provider First Line Business Practice Location Address:
400 S LA BREA AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-2339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-674-6267
Provider Business Practice Location Address Fax Number:
310-673-5904
Provider Enumeration Date:
11/06/2009