Provider First Line Business Practice Location Address:
8473 S VAN NESS AVE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90305-1550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-750-6959
Provider Business Practice Location Address Fax Number:
323-778-4862
Provider Enumeration Date:
09/25/2008