Provider First Line Business Practice Location Address:
645 AERICK ST
Provider Second Line Business Practice Location Address:
STE #4
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-674-2692
Provider Business Practice Location Address Fax Number:
310-674-2232
Provider Enumeration Date:
07/26/2006