Provider First Line Business Practice Location Address:
3213 W IMPERIAL HWY STE A
Provider Second Line Business Practice Location Address:
SAME AS MAILING ADDRESS
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90303-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-590-1330
Provider Business Practice Location Address Fax Number:
310-590-1331
Provider Enumeration Date:
06/30/2007