Provider First Line Business Practice Location Address:
2930 W IMPERIAL HWY
Provider Second Line Business Practice Location Address:
SUITE 200M
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-754-2989
Provider Business Practice Location Address Fax Number:
323-754-2989
Provider Enumeration Date:
06/19/2009