Provider First Line Business Practice Location Address:
423 1/2 S OAK ST
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:
90301-2517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-351-7950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2008