Provider First Line Business Practice Location Address:
2738 W IMPERIAL HWY
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:
90303-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-779-5399
Provider Business Practice Location Address Fax Number:
323-779-5651
Provider Enumeration Date:
02/15/2006