Provider First Line Business Practice Location Address:
10719 S INGLEWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90304-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-677-7911
Provider Business Practice Location Address Fax Number:
310-667-7668
Provider Enumeration Date:
11/11/2008