Provider First Line Business Practice Location Address:
323 NORTH PRAIRIE AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
INGELWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-680-0560
Provider Business Practice Location Address Fax Number:
310-680-0565
Provider Enumeration Date:
10/18/2018