Provider First Line Business Practice Location Address:
1117 W MANCHESTER BLVD
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-215-3555
Provider Business Practice Location Address Fax Number:
310-215-3587
Provider Enumeration Date:
09/11/2009