Provider First Line Business Practice Location Address:
2930 W IMPERIAL HWY STE 200I
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:
90303-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-242-7523
Provider Business Practice Location Address Fax Number:
323-242-7523
Provider Enumeration Date:
07/23/2006