Provider First Line Business Practice Location Address:
2930 W IMPERIAL HWY
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:
90303-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-243-8193
Provider Business Practice Location Address Fax Number:
866-936-1388
Provider Enumeration Date:
12/07/2012