Provider First Line Business Practice Location Address:
160 E TAMARACK AVE
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:
90301-3378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-673-4646
Provider Business Practice Location Address Fax Number:
310-862-1822
Provider Enumeration Date:
10/01/2009