Provider First Line Business Practice Location Address:
301 N. PRAIRIE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
INGLEWOOD
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:
310-412-2126
Provider Business Practice Location Address Fax Number:
310-412-2077
Provider Enumeration Date:
10/02/2008