Provider First Line Business Practice Location Address:
644 E REGENT ST
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-674-3807
Provider Business Practice Location Address Fax Number:
310-674-3810
Provider Enumeration Date:
03/27/2007