Provider First Line Business Practice Location Address:
1101 N LA BREA AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90302-1212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-419-1204
Provider Business Practice Location Address Fax Number:
310-419-1216
Provider Enumeration Date:
01/18/2012