Provider First Line Business Practice Location Address:
2930 W IMPERIAL HWY STE 201
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:
90303-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-945-4732
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2007