Provider First Line Business Practice Location Address:
1210 S LA BREA AVE STE A
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-256-4870
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2012