Provider First Line Business Practice Location Address:
5400 W ROSECRANS AVE
Provider Second Line Business Practice Location Address:
WITH EQUINOX SPA
Provider Business Practice Location Address City Name:
HAWTHORNE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90250-6682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-699-9299
Provider Business Practice Location Address Fax Number:
310-297-9393
Provider Enumeration Date:
09/29/2010