Provider First Line Business Practice Location Address:
171 N. LABREA
Provider Second Line Business Practice Location Address:
206
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:
310-330-0110
Provider Business Practice Location Address Fax Number:
310-330-0220
Provider Enumeration Date:
07/08/2010