Provider First Line Business Practice Location Address:
10920 S LA CIENEGA BLVD
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:
90304-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-549-3400
Provider Business Practice Location Address Fax Number:
310-835-5250
Provider Enumeration Date:
10/02/2006