Provider First Line Business Practice Location Address:
210 S LOCUST 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:
90301-2304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-673-9920
Provider Business Practice Location Address Fax Number:
310-673-9919
Provider Enumeration Date:
07/12/2006