Provider First Line Business Practice Location Address:
575 E HARDY ST
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-4053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-673-6950
Provider Business Practice Location Address Fax Number:
310-671-9989
Provider Enumeration Date:
06/06/2008