Provider First Line Business Practice Location Address:
6818 S LA CIENEGA BLVD
Provider Second Line Business Practice Location Address:
SUITE 202A
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90302-7272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-342-9830
Provider Business Practice Location Address Fax Number:
310-342-9839
Provider Enumeration Date:
07/30/2011