Provider First Line Business Practice Location Address:
2529 W 102ND 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:
90303-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-242-5244
Provider Business Practice Location Address Fax Number:
323-242-7678
Provider Enumeration Date:
03/13/2007