Provider First Line Business Practice Location Address:
103 S LOCUST ST
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:
90301-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-412-3277
Provider Business Practice Location Address Fax Number:
310-412-3223
Provider Enumeration Date:
03/09/2007