Provider First Line Business Practice Location Address:
11222 S LA CIENEGA BLVD
Provider Second Line Business Practice Location Address:
SUITE 233
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90304-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-693-9959
Provider Business Practice Location Address Fax Number:
310-693-9982
Provider Enumeration Date:
02/21/2008