Provider First Line Business Practice Location Address:
431 N PRAIRIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-1413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-671-7172
Provider Business Practice Location Address Fax Number:
310-673-0682
Provider Enumeration Date:
10/18/2006